Methods of treating basal cell carcinoma and glioblastoma

ABSTRACT

Provided herein are methods of treating basal cell carcinoma or glioblastoma by administering coal tar or a coal tar product to a patient with basal cell carcinoma or glioblastoma. The coal tar or coal tar product may be administered as a standalone therapy or in combination with other treatments for basal cell carcinoma or glioblastoma.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.16/155,558, filed on Oct. 9, 2018, which is herein incorporated byreference in its entirety.

FIELD OF THE INVENTION

The present application is directed to methods of treating basal cellcarcinoma and glioblastoma by the administration of coal tar and/or coaltar products.

BACKGROUND OF THE INVENTION

Basal Cell Carcinoma

The basal layer of mammalian epidermis, or stratum germinativum, is thedeepest layer of the five layers of the epidermis and produces new skincells as existing cells die off. It forms a continuous layer of cellsand becomes neoplastic, in most cases, after long-term exposure toultra-violet light from the sun or artificial sources such as tanningbeds that result in damage to the cells' DNA. Basal cell carcinoma (BCC)most commonly appears on skin of the head, neck, and arms and less oftenon areas of the body covered by clothing such as the trunk and legs. Theappearance of BCC varies considerably, presenting as a growth or sorethat does not heal or as a translucent, pink, pearly white, brown,black, or blue slightly raised growth. Occasionally, it may be a white,scar-like lesion called morpheaform BCC, with a waxy appearance. In rarecases, BCC can migrate to nearby muscle, nerve, or bone, causing loss ordamage to these tissues. A schematic depiction of a BCC is shown in FIG.1.

Current treatments for BCC include in-office surgical excision,cryosurgery (liquid nitrogen freezing), curettage-electrodessication,electro-surgery (burning with an electric needle), topical chemotherapy,with agents such as 5-fluorouracil (5-FU) and imiquimod, radiation(disks), electronic skin surface brachytherapy (ESSB), and lasertherapy. Mohs surgery is used on larger BCC tumors with a high risk ofrecurrence and involves repeated surgical removal and freezing of cells,layer by layer, following immediate microscopic examination of eachlayer to determine if there are any remaining cancerous cells, untilnone are detected. This is followed by closure of the opening withsutures, skin grafts, or plastic surgery, if necessary. Mohs surgery hasthe highest rate of cure and is used often for BCC on the face where theneed to preserve skin is paramount.

Glioblastoma

Glioblastoma is a stage IV glioma, a cancer of the glial cells of thebrain and spinal cord. Glioblastomas are aggressive malignancies, alwaysfatal, and the most common type of brain tumor. Once glioblastomas arepresent, a patient's expected median overall survival is between 14 and17 months. The glioblastomas form from a type of cell called anastrocyte; they are thus sometimes referred to as astrocytomas.According to Wikipedia, “glioblastomas can contain more than one celltype (i.e., astrocytes, oligodendrocytes). Also, while one cell type maydie off in response to a particular treatment, the other cell types maycontinue to multiply. Glioblastomas are the most invasive type of glialtumors as they grow rapidly and spread to nearby tissue. Approximately50% of astrocytomas are glioblastomas and are very difficult to treat.”Glioblastoma multiforme (GBM) accounts for over 60% of all brain tumorsin adults. Hanif et al., 2017, Asian Pac. J. Cancer Prev. 18:3-9. Theincidence of glioblastoma is 3.19 per 100,000. Thakkar et al., 2014,Cancer Epidemiol. Biomarkers Prev. 10:1985-96.

Standard therapy consists of surgical resection, followed byradiotherapy within one to four weeks, followed by chemotherapy. Roboticstereotactic radiosurgery is often preferred when the tumor isconsidered inoperable due to location in the brain or patient health.Experimental treatments include immuno-modulators, biopharmaceuticals,such as antibody drug conjugates, boron neutron capture therapy and genetherapy. One such gene therapy is VAL-083, (dianhydrogalactitol), aDNA-targeting agent currently undergoing Phase 2 and Phase 3 clinicaltrials. Murphy et al., Transl Res. 2013 April; 161(4): 339-354.Ad-RTS-hIL-12, an inducible adenoviral vector encoding humanpro-inflammatory cytokine interleukin-12 (IL-12), plus veledimex, anoral activator ligand, is in clinical development for the treatment ofrecurrent or progressive glioblastoma multiforme in adults and beenshown to extend life expectancy by approximately 6 months beyond currentstandards of care.

By the time one feels the symptoms of a glioblastoma, its tentacles arewidespread in the brain. Injection into the tumor is currently notadvisable because the tentacles wrap around the neurons of the brainwithout a visible center where the nucleus would normally be found inother cancers. Because there is no known method of locating the nucleus,injection into the tumor is usually ineffective. Surgery is generallythe first course of treatment resulting in relief of symptoms due to areduction in pressure caused by the bulk of the tumor within the cranialcavity. An average of 98% to 99% of the tumor cells are removed.Fluorescent-guided resection is often employed for extracting out asmuch of the tumor tissue as possible with the goal of extendingsurvival. Stummer et al., 2000, J. Neurosurg. 93:1000-1013. MRI-guidedlaser ablation is another means of resecting as much malignancy aspossible. Kubben et al., 2011, The Lancet 12:1062-1070. Another methodfor locating glioblastoma cells prior to resection employs anon-fluorescent prodrug, 5-Aminolevulinic acid (5-ALA), that causesfluorescent porphyrins to aggregate in malignant glioma cells, whichthen become visible under blue light during a craniotomy. 5-ALA can beadministered to glioblastoma patients intravenously or orally.

Resection is also often followed by post-operative stereotacticradiosurgery. C11 methionine positron emission tomography (MET-PET)imaging helps locate and target the remaining disease within thepartially-collapsed surgical cavity. P. M. Wald, et al., InternationalJournal of Radiation Oncology, Biology, Physics. Volume 96, Number 2S,Supplement 2016. Despite these procedures, glioblastoma cells survive orhave already metastasized to locations beyond reach of the surgeonresulting in tumor regrowth. Since regrowth is rapid, chemotherapeutictreatment is usually immediate.

There have been no new chemotherapeutics capable of crossing the bloodbrain barrier (BBB) approved for glioblastoma in decades. Temozolomide,an agent that alkylates/methylates DNA, remains the most widely used andis taken during radiation therapy. Other agents include carmustine, adialkylating agent, lomustine, an alkylating agent; vincristine, whichbinds to tubulin proteins, cisplatin, an alkylating agent, bevacizumab,an angiogenesis inhibitor, etoposide, an inhibitor of DNA topoisomeraseII, and procarbazine, an alkylating agent. New or repurposed smallmolecules have not been developed in favor of biologics and devicescapable of more precise targeting of radiation.

The blood-brain barrier (BBB) prevents most pharmaceutical compoundsfrom crossing from the blood to the brain and only small molecules arecapable of these feats. In addition to the BBB, glioblastomas form anadditional barrier called the blood-brain tumor barrier (BBTB)) in theperipheral regions, creating a double barrier for drugs. Various drugtransporters, and receptor-mediated drug delivery systems selectivelyenhance drug delivery and exploratory use of cell permeabletumor-targeting peptides on the surface of nanoparticles is underway.Dong X, Theranostics. 2018; 8(6): 1481-1493.

Among the class of drugs called monoclonal antibodies bevacizumab isused to prolong the time between initial treatment and tumor regrowth byactivating the immune system to attack surviving glioma cells.Bevacizumab is delivered via intravenous infusion.

One experimental approach to treating glioblastoma cells post-surgicallyinvolves topical delivery of a chemotherapeutic on a biodegradablepolylactic acid scaffold. It is believed that mesenchymal stem cellsdelivered into the surgical resection cavity on a polylactic acidscaffold will result in tumor killing. Sheets et al, “Image-GuidedResection of Glioblastoma and Intracranial Implantation of TherapeuticStem Cell-seeded Scaffolds”, J. of Visualized Experiments (July 2018).Other research supports the use of encapsulated therapeutic stem cellsimplanted in the tumor resection cavity to induce cell death in gliomas.Kauer et al, Nat Neurosci 15: 197-204.

The U.S. Food and Drug Administration has approved tumor-treating fields(TT Fields), a cap-like device which sends mild electrical chargesthrough the skull to interfere with cancer cell division. The goal is toslow down a tumor's growth or metastatic rate while avoiding harm tonormal cells. TT Fields is not a cure but has the advantage of avoidingthe pain, nausea, fatigue, or diarrhea associated with chemotherapy andradiation.

Irradiated boron isotopes (also known as boron-neutron recapture) havebeen explored as a way of targeting glioblastomas for several decades.In recent clinical trials, patients with malignant glioblastoma treatedwith boron neutron recapture therapy in combination with standardradiation therapy survived significantly longer than those on standardtherapy.

Coal Tar

Coal tar is made by heating coal in coke ovens to drive off volatilematerial. A description of the coking process can be found at the CooperCreek Chemical Corporation website, under the reference titled “How isCrude Coal Tar Derived”. Coal tar is a mixed compound composed primarilyof polycyclic aromatic hydrocarbons, including phenanthrene,acenaphthene, fluorene, anthracene, and pyridine. Coal tar is insolublein water but mostly dissolves in benzene, and partially dissolves inalcohol, ether, chloroform, acetone, carbon disulfide, chloroform, andmethanol.

Virtually all commercially available coal tar is produced as a byproductof the manufacture of blast furnace coke from coal. Modern coke ovensare based on the dry distillation of coal in large horizontal chambers.The chambers are built of ceramic materials to allow heating the coal totemperatures exceeding 1,100 degrees centigrade. This dry distillationcauses the coal to decompose into gas, liquid (tar), and solid coke. Gasand tar are collected in a series of condensers and coolers andprocessed to yield certain articles of commerce and a dry fuel gas.

The liquid product, coal tar, contains a complex mixture of hydrocarbonsand other compounds containing variously, oxygen, sulfur and nitrogen.The key characteristic of all these coal tar components is their highlyaromatic chemical structure, which is the result of the hightemperatures in the coke oven.

When coal tar is used as a medicament, the pitch (27% of coal tar) maybe boiled off above 400 degrees centigrade and may be removed from thefinal medicament by the supplier. Gas chromatography or HPLC can be usedto assure that the coal tar USP used for treating basal cell carcinomaor glioblastoma contains no pitch and matches established consistencystandards.

Recovery of specific coal tar fractions is initially based on theirboiling range and is carried out in standard commercial distillationequipment. Emphasis is normally placed on the following three fractionsin order of boiling range:

1. The light oil, BTX fraction. This fraction contains mainly compoundswith a single aromatic ring, i.e., benzene, toluene and xylenes, hencethe term “BTX.” The boiling points of these three compounds are,respectively, 80, 111, and 138-144 degrees centigrade.2. The naphthalene fraction. This contains most of the valuable chemicalnaphthalene, boiling point 218 degrees centigrade.3. Distillate fraction. This represents the remaining distillablefraction of the coal tar. The higher boiling non-distillable part,commonly referred to as pitch, is removed from the still as liquid. Itusually represents more than half of the original tar.

The distillate fraction leaves the still as vapor from the top of thedistillation tower and is condensed for recovery. The compounds whichmake up the main part of the distillate fraction are known as coal tarfor medicinal purposes.

For further information concerning the above process, see theKirk-Othmer Encyclopedia of Chemical Technology. 1997. New York: JohnWiley & Sons, Inc. Volume 23. “Tars and Pitches.”

As a quality control measure, various methods known in the art may beused to monitor and quantify the top 17 fractions from the distillatefraction (see Example 4). For example, using classic columnchromatography to separate the 17 fractions, monitoring by thin layerchromatography (TLC) where the mobile phase or eluent is pure hexanes(for the first 15 fractions), ethyl acetate (for fraction 16), andmethanol (for fraction 17).

Therapeutic Uses of Coal Tar

One coal tar solution for topical use is described at the UniversalPreserva-A-Chem Inc. website, under the product “coal tar topicalsolution USP”, where the chemical formula, properties, and some synonymsare listed. Coal tar solutions are often referred to as liquor carbonisdetergens (LCD).

According to Wikipedia: “Coal tar was discovered around 1665 and usedfor medical purposes as early as the 1800s. It is on the World HealthOrganization's List of Essential Medicines, the most effective and safemedicines needed in a health system. Coal tar is available as a genericmedication and over the counter. Coal-tar was one of the key startingmaterials for the early pharmaceutical industry.”

Coal tar is available in the United States in a US pharmacopeia (USP)grade with a maximum residue on ignition of 2.0%. Coal tar ointment USP(obtained by combining coal tar with polysorbate 80 (a sorbitanmono-oleate polyoxyethylene derivative) and blending with zinc oxidepaste) and coal tar topical solution USP (made by combining coal tarwith polysorbate 80 and diluting with ethanol to an ethanol content of81.0-86.0%) are also available in the United States.

Coal tar USP is approved for use in the United States in denaturedalcohol, formula 38-B and 38-F. Numerous products, coal tar strengths,dosage forms, routes of administration and brand or generic forms areavailable. Coal tar USP is known to penetrate to the stratumgerminativum.

Raw coal tar is known to pass through the blood brain barrier (BBB) andhave neurological effects. The BBB protects the brain from noxious,electrically charged chemicals that circulate in the blood by preventingthem from entering the brain. Therefore, to pass through the BBB, apharmacologic agent should be non-polar.

The American Society of Health-System Pharmacists; Drug Information2016. Bethesda, MID describes the well-established uses of coal tarproducts for dermatological conditions. Coal tar has been used in themanagement of dandruff, seborrheic dermatitis, and psoriasis, where itreduces the number and size of epidermal cells produced. This has led tothe suggestion that coal tar extracts oxygen from the skin, therebyinhibiting cell reproduction (mitosis) and causing a decrease in thesize and number of cells in the stratum germinativum and stratumcorneum. Another suggestion is that coal tars formulated in varioussoaps and shampoos exert their therapeutic action in patients withdandruff, seborrheic dermatitis, or psoriasis by penetrating theepidermis and removing the scales produced by these skin disorders.Polyphenolic substances and peroxides in coal tar may react withepidermal sulfhydryl groups to produce an effect on skin that is similarto that resulting from exposure to sunlight. This effect couldtheoretically decrease epidermal proliferation and dermal infiltration.

Coal tar preparations are used topically alone or in combination withother drugs (e.g., salicylic acid or sulfur) for controlling dandruff,seborrheic dermatitis, or psoriasis. Although there are fewwell-controlled studies demonstrating their efficacy, coal tarpreparations are used and generally considered effective for relievingthe itching and scalp flaking associated with dandruff; for relievingthe itching, irritation, and skin flaking associated with seborrheicdermatitis; and for relieving the itching, redness, and scalingassociated with psoriasis.

A combination of coal tar components for the treatment of disordersresponsive to dihydrofolate reductase (DHFR)-inhibition is disclosed inU.S. Pat. No. 6,337,337. DHFR catalyzes the NADPH-dependent reduction of7,8-dihydrofolate (H2F) to 5,6,7,8-tetrahydrofolate (H4F) and isnecessary for maintaining intracellular levels of H4F, an essentialcofactor in the synthetic pathway of purines, thymidylate, and severalamino acids. The inventive coal tar compositions described in the '337patent are believed to inhibit the transfer of the hydrogen ion on NADPHto dihydrofolate reductase, thus preventing metabolism within thenucleus of tetrahydrofolate. Because neoplastic cells are moreresponsive than slower-dividing normal cells to this resultinginterference with DNA synthesis, repair, and cellular replication,cancers responsive to antifolate therapy as delineated in the '337patent do not divide and are known to “explode” upon treatment with coaltar products. The '337 patent describes compositions of coal tar asfunctionally replicating the antifolate methotrexate for the treatmentof certain cancers.

Toxicity of Coal Tar

A comprehensive review of the toxicity of coal tar by the U.S.Department of Health and Human Services appeared in 2002 and can befound in the creosote toxicology profile found at the Agency for ToxicSubstances and Disease Registry's website. The document reviews studiesthat provided mixed evidence as to whether coal tar causes squamous cellcarcinoma and other tumors. Much of the research reviewed concernedlong-term occupational exposure in the air or in the factory, oftendecades in the past, when industrial standards of hygiene and workersafety were not as strict as at present. Furthermore, where evidence oftumorigenicity was purportedly found, the effects observed may haverequired a combination of chronic exposure to coal tar or its productsand exposure to sunlight.

Notably, studies did not find a statistical correlation between the useof coal tar products on human skin and cancer incidence. Perhaps thebest data on human coal tar use came from users of coal tar forpsoriasis. In particular, a study by Bhate et al., summarized on page136 of the government review, used a large population, was placebocontrolled, and the cancers sought were extensive. The study found thatthe incidence of cancer (total, skin, breast, cervix, genitourinarytract, bronchus, gastrointestinal tract, lymphoma, or other) was notsignificantly greater in 2,247 patients with psoriasis than in 4,494age-matched controls without psoriasis.

In other studies, reproductive risks in humans were not found, anddespite many reported studies in the review, none could identify abiological risk of any significance to humans (other than benign tarwarts among creosote tar workers with 5 to 40-year exposures), includingto the central nervous system.

There were also studies that examined the effects of some of theconstituents of coal tar (as opposed to the effects of coal tar as awhole). Although some of the studies reviewed would be consideredinadequate by current standards, the results nevertheless indicate thatcoal tar creosote and its constituents can induce skin tumors as well asact as tumor initiators and promoters. Nevertheless, the InternationalAgency for Research on Cancer, the American Conference of GovernmentalIndustrial Hygienists, the National Toxicology Program, and theOccupational Safety and Health Administration reported that no componentof coal tar present at levels greater than or equal to 0.1% isidentified as a probable or confirmed human carcinogen.

SUMMARY OF THE INVENTION

Provided herein are methods of treating basal cell carcinoma orglioblastoma comprising administering to a patient in need thereof atherapeutically effective amount of a coal tar product. In someembodiments, the coal tar product is coal tar USP, coal tar ointmentUSP, or coal tar topical solution USP. In some embodiments, the coal tarproduct is applied topically to a basal cell carcinoma. In someembodiments, the coal tar product is present in a pharmaceuticalcomposition.

Also provided herein are methods of treating basal cell carcinoma orglioblastoma that comprise administering a coal tar product to a patientin need thereof in combination with another therapeutic treatment thatis effective to treat basal cell carcinoma or glioblastoma. In someembodiments, the other therapeutic treatment is a treatment for basalcell carcinoma or glioblastoma is surgical excision, curettage andelectrodessication, Mohs micrographic surgery, radiation, cryosurgery,photodynamic therapy, laser surgery, imiquimod, 5-fluorouracil,vismodegib, or sonidegib. In some embodiments, the treatment is atreatment for glioblastoma and used alone or in combination withsurgical removal, radiation, chemotherapy, tumor treating fields,bevacizumab, polylactic acid or similar scaffolding or encapsulation.

Current treatment of basal cell carcinoma usually requires surgicalremoval as cells in the basal layer are not completely killed by currenttopical treatments. This generally leads to scarring at the surgicalsite. Surprisingly, unlike current topical treatments, coal tar productspenetrate to the basal layer and kill neoplastic basal cell carcinomacells capable of metastasis. Thus, following coal tar product treatment,the remains of the basal cell carcinoma or glioblastoma may be simplyfrozen off, leaving the skin in pristine condition once the epidermisheals.

As an alternative to cryotherapy, the remaining basal cell carcinoma maybe scraped off (curettage) by a medical professional, similar to thecurrent method of removing actinic keratoses. The benefit of cryotherapyor curettage is faster removal and recovery to a normal appearance.

In some embodiments, the coal tar product is administered before theother therapeutic treatment. In some embodiments, the coal tar productis administered after the other therapeutic treatment. In someembodiments, the coal tar product is administered at the same time asthe other therapeutic treatment.

In some embodiments, the coal tar product and the other therapeutictreatment are administered together, in a single pharmaceuticalcomposition. In some embodiments, the coal tar product and the othertherapeutic treatment are administered separately, in differentpharmaceutical compositions. In some embodiments, the coal tar productis administered topically or as a therapeutic dressing to the lining ofa post-surgical cavity and the other therapeutic treatment isadministered with a device (e.g. gamma knife), topically, orally,intravenously, or subcutaneously. In some embodiments, the coal tarproduct is administered intravenously, and the other therapeutictreatment is administered with a device (gamma knife), topically,orally, intravenously, or subcutaneously.

Following treatment with a coal tar product and, optionally, anothertherapeutic treatment, daily or frequent (e.g., 1× weekly, 2× weekly, 3×weekly, 4× weekly) application of a low concentration of a coal tarproduct (e.g., coal tar USP as a 0.1% to 0.5% alcohol solution) by thepatient to the affected area is advised to prevent or delay recurrenceof the basal cell carcinoma.

Before or following removal of a glioblastoma, and, optionally, anothertherapeutic treatment, application to the surgical cavity prior toclosure of a coal tar product (e.g., coal tar USP at 0.00005% to 0.5% inan ethanol, lactic acid, or dipropylene glycol (DiPG) solution, or in amixture comprising 50% DMSO, 35% PEG 400 and 15% ethanol and excipients,or incorporated into a delivery vehicle such as a polylactic acidscaffold). See FIG. 2.

Thus, disclosed herein is a method of preventing basal cell carcinomacomprising administering to a patient who previously was treated forbasal carcinoma a therapeutically effective amount of a coal tarproduct. In some embodiments, the coal tar product is administered to anarea of the patient's skin where a basal cell carcinoma previouslyappeared and was treated, and the method prevents the recurrence of thebasal cell carcinoma. In some embodiments, the coal tar product isadministered to an area of the patient's skin near (within about one ortwo inches) where a basal cell carcinoma previously appeared and wastreated, and the method prevents the appearance of a new basal cellcarcinoma.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a schematic depiction of a basal cell carcinoma and typicalincision for surgical removal.

FIG. 2 shows the growth inhibition bar graph of assays conducted at theU.S. National Cancer Institute of a composition derived from coal tar(see Example 4) on the CNS cancer cell lines glioblastoma SF-268 andastrocytoma U251.

FIG. 3A-C shows basal cell carcinoma on the forehead of a patient priorto first treatment (see Example 1). A, before treatment; B, duringtreatment; C, after treatment.

FIG. 4A-C shows a basal cell carcinoma on the right forehead of the samepatient that occurred four years after the basal cell carcinoma of FIG.3A-C was treated. A, before treatment; B, during treatment; C, aftertreatment. See Example 1.

FIG. 5A-B shows two basal cell carcinomas on the right and left foreheadof the same patient that occurred four years after the basal cellcarcinoma of FIG. 4A-B was treated. See Example 1. Before and afterphotos of the left and right basal cell carcinoma are shown in 5A(before treatment with coal tar USP) and 5B (after treatment with coaltar USP).

FIG. 6A-B shows a close up of the basal cell carcinoma on the patient'sright forehead before (A) and after (B) four months of daily topicaltreatment and after eventual cryotherapy. The arrow and circled area in6B indicate the location of the basal cell carcinoma.

FIG. 7A-B shows the right side and center of the patient's foreheadwhere large basal cell carcinomas appeared four years and one yearprevious to the time the photo was taken. See Example 1. A, area afterpreventative treatment 1 to 2 times daily with 0.1% coal tar USPdissolved in alcohol applied via cotton balls since the last basal cellcarcinoma was removed. B, close up of the far-right side portion of A.

FIG. 8A-B shows close up views of the patient's left forehead before andafter 12 days of 0.3% of the composition of Example 4 in alcoholsolution applied topically twice daily. The images show loss of earlystage BCC growths and BCC shrinkage. A, before application; B, after 12days of application.

FIG. 9A-C shows before (A), during (B) and after (C) photos of a basalcarcinoma that appeared from blemished skin on the patient's foreheadand was treated 2× daily for 12 days (B) and then an additional 14 days(C) with the composition of Table 12 in Example 4.

DETAILED DESCRIPTION OF THE INVENTION

“Administering” refers to providing a coal tar product or apharmaceutical composition comprising a coal tar product to a patient inneed thereof by any means known in the pharmaceutical art and includesself-administration by the patient as well as administration by aphysician or other health care provider. “Administering” includes localdelivery of a coal tar product directly into or onto a target tissue(such as topical administration to a basal cell carcinoma or injectioninto a basal cell carcinoma or topical delivery to the lining of asurgical cavity after brain tumor removal).

“Coal tar product” refers to a therapeutic agent derived from coal tar.In some embodiments, the coal tar product has efficacy in treating basalcell carcinoma. In some embodiments, the coal tar product has efficacyin treating glioblastoma. Examples of “coal tar products” include coaltar USP, coal tar topical solution USP, and coal tar ointment USP.

“Patient” preferably refers to a human but may also refer to companionanimals such as dogs or cats, or farm animals such as horses, cattle,pigs, or sheep.

“Pharmaceutically acceptable” refers to a carrier, diluent, or excipientthat is compatible with the other ingredients of a formulation and isnot deleterious to the patient to whom the formulation is administered.

“Therapeutically effective amount” refers to an amount of coal tarproduct that results in a desired change in the physiology of thepatient to which a coal tar product is administered, e.g., a reductionin the size of a basal cell carcinoma or a glioblastoma.

Surprisingly, coal tar USP in a pharmaceutically acceptable carrier hasbeen found to be effective against cancers not responsive to antifolatetherapy such as methotrexate. In particular, and unexpectedly, coal tarUSP in an acceptable pharmaceutical carrier is shown to be effective fortopically treating basal cell carcinomas. Basal cell carcinomas arecurrently often treated with the Mohs surgical method of slicingcontiguous layers of skin until no additional cancer cells are observedthrough high magnification in the sample slice. This method, however, isnot a cure and recidivism is common. A chemical bathing of the basallayer with a coal tar product derived anti-cancer agent such asdisclosed herein offers a more complete and less disfiguring therapy tothe patient. Furthermore, low-dose follow-up application has been shownto prevent recurrence in the immediate area and in the broader proximityto the initially-treated basal carcinoma.

Equally surprising, coal tar USP in an acceptable pharmaceutical carrierat a concentration of 100 μg/ml inhibited the growth in vitro ofglioblastoma multiforme cells (U251, a grade IV astrocytoma) by 100% andastrocytoma cells (SF-268 cell line) by 91% in assays completed at theU.S. National Cancer Institute (NCI). See FIG. 2. The use of a coal tarbased therapeutic in each cancer offers a preferable method of treatmentover surgical resection, which is rarely a cure as some cancerous cellsremain behind, regrow, or metastasize.

Optionally, if surgical removal of the tumor is recommended, topical useof a coal tar based therapeutic to the lining of the surgical cavityafter tumor resection, alone or in combination with other medicaments ortreatments, provides additional cell-kill of glioblastoma multiformecells that are beyond the reach of surgical instruments or left in placedue to proximity to critically functional neurons, such as speech.

While not intending to be bound by theory, one possible explanation forthe effectiveness of coal tar products in treating glioblastoma is basedon their non-competitive binding, electron transport, or allostericeffect on NADPH. Neoplastic cells are more responsive than slowerdividing normal cells to this resulting interference with DNA synthesis,repair, and cellular replication that results from NADPHhydrogen-transfer inhibition.

Moreover, tumorigenic cells generally require higher levels of NADPHthan wild-type cells due to, e.g., their greater mitotic activity andneed for anti-oxidative functions, particularly during chemotherapeuticor radiation therapy. NADPH is used by glioblastomas to surviveradiation treatments by increasing production of deoxynucleotides andantioxidants, specifically glutathione and thioredoxin, which helpreduce oxidative stress after radiation and repair radiation-induced DNAdamage. Inhibiting the production of enzymes producing NADPH resulted ingreater sensitivity by glioblastomas to both in vitro and in vivoradiation. See Spitz et al., 2004, Cancer Metastasis Reviews 23:311-322.Inhibiting NADPH production could potentiate the effectiveness ofradiation therapy of glioblastoma since glioblastomas differ fromsurrounding normal tissue with respect to NADPH metabolism andinhibition of the NADPH-producing enzyme isocitrate dehydrogenase 1(IDH1) sensitizes glioblastomas to radiation in vitro and in vivo byinducing NADPH-dependent cellular senescence. Temozolide, the primaryradiosensitizer currently in use, has only modest efficacy. Although itis widely used in combination with surgery and radiation, mostglioblastoma patients still die due to recurrences within the high doseradiation field. Wahl et al., 2017, Cancer Res. 77:960-970.

Accordingly, disclosed herein is a method of sensitizing glioblastoma toradiation treatment by inhibiting or interfering with thereducing-capacity of NADPH comprising administering to a patient havingglioblastoma a therapeutically effective amount of a coal tar product.In some embodiments, the patient is then administered a therapeuticallyeffective dose of radiation at the same time as or after beingadministered the coal tar product.

In some embodiments, the methods of treating basal cell carcinomadisclosed herein eliminate the need for surgical removal of basal cellcarcinoma growths and the risk to adjacent skin when chemotherapeuticointments or creams are used. The medicaments disclosed herein are notharmful to normal skin and attack and kill only basal cell carcinomacells.

Combination drugs are generally more effective than single-moleculedrugs, since malignant cells often can cope when exposed to onechemical, but when two or more are put together, the therapeuticresponse is generally stronger and often enough to stop cell growth andinduce tumor cell death. Coal tar USP, being a combination of manymolecules in one drug, has the benefit of overwhelming the defensesmalignant cells use to become drug resistant.

The efficacy of coal tar described herein on two tumor types that arenot responsive to dihydrofolate reductase (DHFR) inhibition—basal cellcarcinoma and glioblastoma—is surprising in view of the teachings ofU.S. Pat. No. 6,337,337, which discloses the antitumor effects of coaltar products as arising via a mechanism similar to that of DHFR.

Pharmaceutical Compositions

When the coal tar products disclosed herein are administered aspharmaceuticals to humans or animals, they are generally given as apharmaceutical composition containing, for example, about 0.00005 to 3%,about 0.001 to 2.5%, about 0.5 to 2%, or about 1 to 1.75% (w/w, w/v, orv/v) of coal tar product in combination with one or morepharmaceutically acceptable carriers. In some embodiments, thepharmaceutical composition contains about 0.00005%, about 0.001%, about0.01%, about 0.03%, about 0.05%, about 0.075%, about 0.1%, about 0.2%,about 0.3%, about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8%,about 0.9%, about 1.0%, about 1.1%, about 1.2%, about 1.3%, about 1.4%,about 1.5%, about 1.6%, about 1.7%, about 1.8%, about 1.9%, or about 2%(w/w, w/v, or v/v) of coal tar product in combination with one or morepharmaceutically acceptable carriers.

In some embodiments, the pharmaceutical composition comprises coal tarUSP at about 2% wt/wt diluted in DMSO, ethanol, or dipropylene glycol(DiPG).

Dosage levels of the coal tar products in the pharmaceuticalcompositions may be varied so as to obtain an amount of the coal tarproduct which achieves the desired therapeutic response for a particularpatient and mode of administration, without being toxic to the patient.

The dosage level will depend upon a variety of factors, including theactivity of the particular coal tar product, the route ofadministration, the time of administration, the rate of excretion ormetabolism of the coal tar product, the rate and extent of absorption,the duration of the treatment, whether other drugs are also beingadministered to the patient, the age, sex, weight, condition, generalhealth, and prior medical history of the patient being treated, and likefactors well known in the medical arts.

In general, a suitable daily dose of a coal tar product disclosed hereinwill be that amount of the coal tar product which is the lowest doseeffective to produce a therapeutic effect. Such an effective dose willusually depend upon the factors described above. Generally, oral,intravenous, and subcutaneous doses of the coal tar product for apatient will range from about 0.0001 to about 200 mg, or about 0.001 toabout 100 mg, or about 0.01 to about 100 mg, or about 0.1 to about 100mg, or about 1 to about 50 mg per kilogram of body weight of the patientper day.

The coal tar products can be administered as a single dose, daily, oncea day, twice a day, three times a day, or more. Other schedules includeevery other day, three times a week, twice a week, weekly, or bi-weekly.The dosing schedule can include a “drug holiday,” i.e., a period of timewhen the coal tar product is not administered. For example, the coal tarproduct can be administered for two weeks on, one week off, or threeweeks on, one week off, or four weeks on, one week off, etc., orcontinuously, without a drug holiday. The coal tar products can beadministered orally, intravenously, intraperitoneally, topically,transdermally, intramuscularly, subcutaneously, intranasally,sublingually, by inhalation, or by any other route.

In order to produce pharmaceutical compositions, coal tar products aregenerally dissolved in solvents. Some coal tar solvents are composed ofneutral, acidic, or basic cyclic compounds characterized by the presenceof a six-membered ring in the molecule and most are soluble with eachother. Coal tar USP is only slightly soluble in water and partiallysoluble in acetone, alcohol, carbon disulfide, chloroform, ether, andmethanol. These solvents may be used alone or in combinations. Moreover,solvents in addition to those mentioned above may be used.

For use on basal cell carcinoma requiring delivery to the basal layer, apreferred solvent system for coal tar USP is a mixture of ethanol (IPA99%), dipropylene glycol (DiPG), PEG 400 monostearate and acetic acid.The preferred ratio is 48-50% ethanol, 30% DiPG, 15% PEG 400 and 3-5%acetic acid. Any remnant pitch (or solutes) will precipitate immediatelyor within 24 hours after mixing and will adhere to plastic containers orcan be filtered out through a porous membrane.

Dipropylene glycol, chemical formula C₆H₁₄O₃, is a mixture of threeisomeric chemical compounds, 4-oxa-2,6-heptandiol; 2-propan-1-ol; and2-propan-1-ol. It is a colorless, nearly odorless liquid with lowtoxicity and a molar mass of 134.173 g/mol. Dipropylene glycol iscommonly used in pharmaceutical formulations as it is miscible withwater and soluble in ethanol.

It is well known that DiPG is a skin penetrant and one of the preferreddiluents for the delivery of topical drugs to the skin. The MSDS forDiPG can be found in the Environmental Working Group's cosmeticsdatabase website. A minimal amount of acetic acid in the solvent mixturewill help soften and exfoliate the corneocytes in the stratum corneumwhere lipids in these cells can otherwise trap the medicament.

Other solvents or partial solvents of the polycyclic aromatichydrocarbons found in coal tar USP are isopropyl myristate, PEG 600,Cremophor® EL PEG-35 Castor Oil, ethanoic acid (aqueous acetic acid),avocado oil, sesame oil, tocopherol oil (Vitamin E), and castor oil.Other more exotic oils may also serve as either solvents or odor-maskingdiluents, including clove leaf oil, oil of rosemary, geranium Egyptianoil, oil of lemon and oil of juniper berry. These solvents and diluentscan be used alone or in combination with other solvents.

For delivery of coal tar USP to a basal cell carcinoma, xanthan (from,e.g., CP Kelco) or guar gum may be added to an aqueous formulation at aconcentration of approximately 0.5% to approximately 2.5% by firstwetting the gum for at least one hour in one or more of oily solvents orfragrances, then adding this mixture to the coal tar USP solution andmixing together at a speed sufficient to create a vortex for 45 to 60minutes. This will produce a gel consistency and allow the medicament toremain in place on the basal cell carcinoma, which is especially usefulwhen treating basal cell carcinoma above the eyes or at the hairlinewhere run-off might otherwise occur. A lower amount of xanthan gum(<0.5%) may also be added to a maintenance-level formulation (e.g., 0.1%coal tar USP) to increase adherence to the skin on the forehead andelsewhere.

Technologies and methods for topical delivery of coal tar products tobasal cell carcinomas include unit dosing dispensing devices, needle,microneedle, non-needle injection devices, prefilled applicators such asinfused pads, saturated wipes, adhesive bandages or tabs, creams, gels,and ointments, including petrolatum-based ointments.

A preferred method of topical delivery of a coal tar product to a basalcell carcinoma is to simply apply the coal tar product by hand to thebasal cell carcinoma. In this embodiment, the coal tar product ispreferably in a cream, ointment, lotion, or other similar form, and isplaced upon the basal cell carcinoma, avoiding the surrounding normaltissue to the extent possible. Either the patient or a health careprovider may apply the coal tar product to the basal cell carcinoma. Theamount of cream, ointment, lotion of other form of product applied willdepend on the size and/or location of the basal cell carcinoma and willbe readily ascertained by the patient or healthcare provider who appliesthe coal tar product.

In some embodiments, the coal tar product is allowed to remain at thesite of application on the basal cell carcinoma. That is, it is notwiped off or otherwise removed after a certain period of time. However,in some instances, it may be desirable to wipe off the coal tar productafter a certain period of time, e.g., 15 minutes, 30 minutes, 45minutes, one hour, two hours, three hours, four hours, five hours, sixhours, seven hours, eight hours, nine hours, ten hours, or longer.

In some embodiments, the coal tar product is applied to the basal cellcarcinoma with a foam or cotton pad. In some embodiments, the coal tarproduct is applied with a bandage to seal the ointment, cream, or othertopical delivery composition against the basal cell carcinoma. Thelength of time the bandage is left on depends on various factors such asthe dose of coal tar product being applied and the nature (e.g., size,location) of the basal cell carcinoma.

Delivery to Central Nervous System (CNS) Tumors

In general, drugs that pass through the blood brain barrier (BBB) aresmall, non-polar, lipid-soluble molecules that permeate via diffusion.Permeability depends on many factors (molecule shape, flexibility,surface area, etc.) but two of the main characteristics that influencepermeability are size and solubility. The molecular weight threshold forpermeability is around 400 Da. Coal tar USP (with pitch removed) weighs210-250 Da. In terms of the solubility threshold, if a drug forms lessthan 7 hydrogen bonds with water, there's a higher chance that it willpass the BBB. Coal tar USP is only slightly soluble in water and moresoluble in lipids.

A discussion of the BBB and methods to overcome it can be found at theQuora website, under the question “What is the mechanism which allowsdrugs to pass across the blood brain barrier?” as answered by JensMowatt. A summary of the characteristics of drugs that pass through theBBB is found in Pardrige, 2012, J. Cereb. Blood Flow. Metab.32:1959-1972.

Once a drug passes through the BBB, it has to partition into an aqueousenvironment. To assure that coal tar USP retains its integrity in thisaqueous environment, coal tar USP may be formulated with the solventdipropylene glycol, a lipid, and optionally an alcohol to maintainhydrophobicity for passage through the BBB and, once in the brain, a lowlipid content to avoid uptake by peripheral tissue and loss of drugcharacterization or dosage.

For delivery to the brain, long-lasting nano-injectables, includingliposomes, polymeric nanoparticles, nanocrystals, microspheres,drug-implanted polymers, and antibody drug conjugates are preferred.Transmucosal delivery, inhalation, and oral formulations are alsopreferred. Such non-invasive methods of delivery of coal tar USP arepreferred over injection due to the difficulty in locating the nucleusof the glioblastoma tumor as it winds its tentacles around the nerves.Unless the center of the tumor is located, injection treatments areineffective. It is anticipated that coal tar USP delivered by inhalationor through the mucosal tissue of the nose will be effective as someantibiotics with true benzene rings are used to treat CNS infection andpass through the blood brain barrier. These include isoniazid,pyrazinamide, linezolid, fluconazole, and fluoroquinolone. Additionally,one of the dominant compounds in coal tar USP, quinoline, passes throughthe blood brain barrier via passive diffusion.

As an alternative to encapsulation with a non-polar coating, drugdelivery of coal tar products to glioblastomas through the blood streamand the blood brain barrier can be achieved by removing anyelectrically-charged particles from coal tar as described in U.S. Pat.No. 5,354,475.

Coal tar products also may be injected or surgically implanted directlyinto the brain in order to treat glioblastomas. This approach has theadvantage of reducing the side effects of any interactions of the coaltar product with other tissues or organs. One possibility is to use animplantable, slow-dissolving polymer wafer containing the coal tarproduct. Such a slow-dissolving polymer wafer containing carmustine(GLIADEL®) has been approved by the U.S. Food and Drug Administrationfor treating glioblastoma and may be adapted by those skilled in the artto deliver coal tar products to glioblastomas. See Perry, et al., 2007,Curr. Oncol. 14:189-194, for a discussion of GLIADEL®.

Nasal administration of medication for the treatment ofneurodegenerative diseases has proven to be a way to bypass the bloodbrain barrier including large, polar molecules via olfactory andtrigeminal nerves, despite some issues around irregular drug absorption,variation in absorption in different regions of the brain, and nasalcongestion. Drugs currently delivered intranasally include anti-migrainedrugs like IMITREX® (sumatriptan), ZOMIG® (zolmitriptan), MIGRANAL®(dihydroergotamine), and SINOL-M®. More examples include peptide drugs(used for hormone treatments and given intranasally to avoid drugdegradation after oral administration) such as desmopressin. Synctocinoncan be given intranasally to increase duration and strength ofcontractions during labor. Intranasal calcitonin is given for a varietyof conditions and intranasal midazlolam is used for seizure episodes inchildren. Investigations also show that intranasal naloxone for opiateoverdoses can be just as effective as by injection. Additionally, manyrecreational drugs are taken intranasally.

Drug delivery via the lungs is an effective way not only for local butalso for systemic treatment. In general, the lungs are permeable to bothsmaller molecules and larger macromolecules, as well as lipophilic andwater-soluble small molecules. The benzenes in coal tar USP enter thebloodstream via respiratory pathways. Several compounds also found incoal tar USP, namely pyrene (see U.S. Patent Application Publication No.US 2009/0238754 and International Patent Publication WO 2009/117042) andnapththalene (see Freed et al, 2002, Peptides 23:157-65) traverse theblood brain barrier. Seizures are also treated with medicines deliveredthrough the lungs, including STACCATO®, an epilepsy drug in clinicaltrials from Engage Therapeutics.

Post-surgical delivery of a coal tar product to the cavity bed of anexcised tumor offers another method of reducing tumor regrowth andmetastasis and extending longevity.

Additional Delivery Methods

Various other methods known in the art may be used to deliver coal tarproducts for use in the methods of therapy described herein.

For example, liposomal delivery is a well-established means ofdelivering drugs, particular drugs used to treat cancer. See, e.g.,Drummond et al., 1999, Pharmacol. Rev. 51:691-743. Liposomes arenon-toxic, biodegradable and may provide better solubility and stabilityas well as slower release of drugs, as opposed to free administration. Arecent variation of liposomal technology that may be employed in themethods described herein are the cell-penetrating peptide amphiphileintegrated liposomal systems for enhanced delivery of anticancer drugsto tumor cells described in Sardan et al., 2013, Faraday Discuss166:269-83.

Another possible method of delivering coal tar products is viamicroneedle patches, which are arrays of needles measuring hundreds ofmicrons in length that can deliver medication into the skin in apain-free and simple manner. See, e.g., Prausnitz, 2017, Ann. Rev. Chem.Biomol. Eng. 8:177-200.

Transdermal patches are also a possible delivery method and provide forthe movement of drugs across the skin for absorption into the systemiccirculation, relying on either passive means that do not disrupt thestratum corneum or active means which do. See, e.g., Pastore et al.,2015, Br. J. Pharmacol. 172:2179-209.

Excipients known to be compatible with normal brain tissue function asdiluents, solvents, penetration enhancers and time-release agents tomaximize the benefit of the coal tar product.

EXAMPLES Example 1—Treatment of Basal Cell Carcinomas on Human Skin

An ointment consisting of 95% petrolatum and 5% coal tar solution USP(see U.S. Pat. No. 6,337,337 and Example 4 below) was applied 2× day for13 days to a basal cell carcinoma on the forehead of a human female.Shown in FIGS. 3 A, B, and C is the BCC before, during, and aftertreatment, respectively.

Four years later, the same patient was treated for basal cell carcinomaon the right forehead. Treatment consisted of twice daily applicationsfor 10 days of a liquid solution containing refined coal tar (Koppers,Inc., Pittsburgh, Pa., brand NSR, Stickney Plant, LDO #2006-0566, Sample06-244) in 65% ethanol and 35% Polyethylene glycol (PEG) 400 v/v at aconcentration of about 2%. Listed in Table 110 are the compounds foundin the Koppers coal tar product sold to industry for dandruff shampoomanufacturing. This treatment was combined with cryotherapy using liquidnitrogen to freeze off the basal cell carcinoma. The results of thetreatment are shown in FIGS. 4A (before treatment) and 4B (aftertreatment). On the day of the last treatment, and just before removal,the tumor was seen to be scaling and starting to flake.

A third treatment of the same patient occurred four years after thesecond treatment when two basal cell carcinomas appeared on the samesubject's forehead, one on the left side and one on the right side.During the intervening period_no treatment of the forehead occurred. Twocoal tar USP formulations were used to shrink these basal cellcarcinomas: Coal tar USP (Spectrum Chemical; CAS Number: 8007-45-2;available through VWR's website under “Coal tar USP”) was combined witha mixture of 120 grain vinegar (Fleischmann's, 12% acetic acid) andgrapeseed oil (Columbus Foods) as shown in the formula of Table 3 andapplied 2× day. The second formulation using the same Spectrum Coal tarUSP was also applied to both basal cell carcinomas 2× daily. This secondformulation is also encompassed by Table 3. The basal cell carcinomashrunk by about 50% on the right forehead above the right eye prior tocryotherapy. The basal cell carcinoma on the left side also shrunk about50%. Before and after photos of the left basal cell carcinoma are shownin FIG. 5A (before treatment with coal tar USP), 5B (after treatmentwith coal tar USP). FIGS. 6A and 6B shows both basal cell carcinomas onthe left and right side of the patient's forehead before treatment andupon completion of the topical coal tar treatments when cryotherapyremoved the remaining basal cell carcinoma on the right side.

FIGS. 6A and B shows a close up of the basal cell carcinoma on thepatient's right forehead before (A) and after (B) four months of dailytopical treatment and after eventual cryotherapy as described in theparagraph above.

FIG. 7A shows the right side and center of the patient's forehead wherelarge basal cell carcinomas appeared four years ago (FIG. 4) and again,one year ago (FIG. 5). Following removal of the last basal cellcarcinomas, this area has been treated 1 to 2 times daily with 0.1% coaltar USP dissolved in alcohol applied via cotton balls and no new basalcell carcinomas have developed. FIG. 7B is a close up of a portion ofFIG. 7A, with the white areas being scars from prior surgeries for theremoval of basal cell carcinomas.

The patient had a purple blotch on her center forehead for six monthswhich eventually produced a new basal cell carcinoma (see FIG. 9A). Atthat point, the composition of Table 12 in Example 4 was applied 2×daily for 21 days, at which point the cyst had flattened, desiccated andcontracted in diameter (see FIG. 9B).

Example 2—Treatment of Astrocytomas and Glioblastoma Multiforme

Currently, dihydrofolate reductase (DHFR) inhibitors are not being usedor clinically studied for the treatment of astrocytomas orglioblastomas. It is therefore surprising that coal tar USP would beeffective in killing two cell lines of these brain cancers, SF-268 andU-251. However, studies done at the U.S. National Cancer Instituteshowed that a coal tar product (see Example 4 below) inhibited thegrowth in vitro of glioblastoma multiforme cells (U251, a grade IVastrocytoma) by 100% and astrocytoma cells (SF-268 cell line) by 91%.See FIG. 2.

Example 3—Formulations

TABLE 1 Ingredient Concentration (v/v) Coal tar USP 0.005 to 2%  DiPG 1% to 15% One or more lipids, preferably grapeseed oil or 2% to 5%castor oil Water to 100%

This formulation is suitable for intravenous infusion and may be used ata dose and schedule of 10 mg/kg to 15 mg/kg every 2-3 weeks. Otherroutes of injection may also be used, e.g., intramuscular, subcutaneous,or intraperitoneal.

Another formulation is shown below. In this formulation, water is usedin combination with xanthan gum to make a gel. To mask the odor of coaltar USP, a de minimus amount of wintergreen oil (for example 0.025%) or1% to 2% of a vanilla, flower-scented or similar pleasant fragrance oilcan be added. This formulation is suitable for topical administration.

TABLE 2 Ingredient % of formulation (v/v) Function Castor oil 25 solventDenatured alcohol 25 solvent Coal tar USP 2 active ingredient Xanthangum 1.6 thickener, masker Wintergreen oil 0.025 fragrance Deionizedwater 46.375 diluent

Another formulation contains aqueous acetic acid in the form of whitevinegar (120 grain or 12% acetic acid) and grapeseed oil to create anoil/water emulsion which must be shaken before application to the skin.This formulation was used in the treatment of basal cell carcinoma onthe patient disclosed in Example 1 above.

TABLE 3 Ingredient Weight (grams) Percent of formulation Aqueous 12%acetic acid 9.6 27.7 Grapeseed oil 24.5 70.6 Coal tar USP 0.6 1.7 Totals34.7 100

The formulation in Table 3 was prepared as follows:

1. The aqueous 12% acetic acid and grapeseed oil were added to a mixingvessel and stirred on low for 15 minutes.

2. The coal tar was added to the mixing vessel and stirring at mediumspeed was carried out for 45 minutes, creating a small vortex.

3. The mixture was run through a homogenizer and filtered to removeparticulates.

Hexane is not to be used in this formulation due to suspected damage tothe central nervous system.

In one embodiment of the formulation of Table 3, the suppliers of theingredients were as follows:

TABLE 4 aqueous 12% Fleischmann's Vinegar Company, Inc. acetic acid12604 Hiddencreek Way, Suite #A Cerritos, CA 90703 grapeseed oilColumbus Foods, 30 East Oakton St., Des Plaines, IL 60018 Coal tar USPSpectrum Chemical Manufacturing Corp., 769 Jersey Avenue, New Brunswick,NJ 08901-3605

Particularly for methods of treating basal cell carcinoma, coal tartopical solution can be substituted for coal tar USP. The U.S.Pharmacopeia provides the following description of how coal tar topicalsolution may be made in the USP Monograph for “Coal Tar TopicalSolution”.

TABLE 5 coal tar topical solution Ingredient Concentration (v/v) Coaltar 200 g Polysorbate 80 50 g Alcohol, a sufficient quantity to make1000 ml

Mix the coal tar with 500 g of washed sand and add the polysorbate 80and 700 ml of alcohol. Macerate the mixture for 7 days in a closedvessel with frequent agitation. Filter, and rinse the vessel withsufficient alcohol to make the product measure 1000 ml. Preserve theproduct in tight containers. Alcohol content will be between 81% and86%.

Yet another formulation, suitable for topical use in the treatment ofbasal cell carcinoma, is as follows:

TABLE 6 coal tar topical solution Ingredient % of formulation (v/v)Ethanol SDA 40B, 200 proof 45.58 Dipropylene glycol 31.91 Polyethyleneglycol 600 13.67 Coal tar USP  1.55 Grape seed oil  7.29 100%

The ethanol, dipropylene glycol, and polyethylene glycol 600 arecombined and mixed for 20 minutes. Coal tar is added to the mixture andblended for 60 minutes. Finally, the grape seed oil is added, and theformulation is mixed for another 60 minutes.

For a formulation suitable for injection, the ethanol SDA 40B, 200 proofis replaced by ethanol solution, denatured, sterile, made with USP waterfor injection, 70%.

Other formulations suitable for treatment of basal cell carcinomainclude the following.

TABLE 7 Ingredient % of formulation (v/v) Castor oil 20-30% Denaturedalcohol 20-30% Coal tar USP 0.05-2%  Xanthan gum  1-3% Wintergreen oil0.025% Deionized water 40-55%

TABLE 8 Ingredient % of formulation (v/v) Aqueous 12% acetic acid 20-35% Grapeseed oil  65-80% Coal tar USP 0.5-2.5%

TABLE 9 Ingredient Amount Coal tar 50-250 g Polysorbate 80 40-60 gAlcohol, a sufficient 1000 ml. quantity to make

Table 10 discloses a solvent mixture that may be used to prepare aformulation of a coal tar product.

TABLE 10 Ingredient % of formulation (v/v) DMSO 50% PEG 400 35% Ethanol15%

Example 4—Composition Derived from Coal Tar

This example discloses a composition derived from liquor carbonisdetergens from Koppers, Inc. through fractional distillation andstandard GCMS. It comprises a mixture of 17 fused, 3-ring arenes. TheU.S. National Cancer Institute and other laboratories have shown thatthe individual molecules comprising this “cocktail” have minimal or noeffect as oncolytics. In vitro assays have also shown that thecomposition does not inhibit the functioning of the pentose phosphatepathway in normal cells.

The composition is soluble in ethyl alcohol, DMSO, acetic acid, IPA,dichloromethane and dimethylformamide and is described in U.S. Pat. No.6,337,337. See the table at column 4, lines 20-36, reproducedimmediately below as Table 11 of this application.

TABLE 11 Composition constituents Hydrocarbon Percent by weightPhenanthrene 21.1 Fluoranthene 9.07 Anthracene 7.45 Biphenyl 6.83 Pyrene6.54 Fluorene 5.58 Naphthalene 4.08 Carbazole 3.41 Dibenzofuran 3.252-methylnaphthalene 1.33 Chrysene 0.87 Benzo(a)anthracene 0.761-methylnaphthalene 0.63 Acenaphthene 0.46 Indene 0.40 Quinoline 0.30Tar Pitch 27.93 TOTAL 100%

One skilled in the art would understand that there is some variationpossible in the concentrations of the individual components making upthe composition. In particular, some of the lower concentrationcomponents may be dispensed with.

Optionally, compounds defined generically as tar pitch may be removedfrom the composition before it is used therapeutically. To remove thetar pitch and solid particulates not dissolved with solvents, a depthfilter method may be used as, e.g., described at the Wikipedia websiteentry for “Depth filter”.

Dark or brown discoloration of the basal cell carcinoma with thecontinuous application of a coal tar-based salve or solution can be acosmetic issue for patients. One method of lightening the compound is todilute it in any one of the solvents described herein and then filterthis solution through activated charcoal.

As an alternative to the production of compositions from coal tar,compositions may be prepared by obtaining the individual chemicalcomponents listed above and mixing them in desired proportions. One suchpossibility is the composition produced by SPEXCertiPrep, CRM Division,Metuchen, N.J., the components of which are shown below in Table 12.This level of 1.27% final concentration of chemically-reproduced coaltar in a DMSO solution is sufficient to be used as a topical for BCC andcan be diluted for use in the treatment of glioblastomas, if necessary.Compositions produced by mixing individual components will generally notinclude pitch. The adjustment of pH can be managed by the addition ofsodium phosphate.

TABLE 12 Composition constituents Hydrocarbon mixture Percent (1.27% offinal solution) (wt/wt) Phenanthrene 29.3 Fluoranthene 12.6 Anthracene10.3 Biphenyl 9.5 Pyrene 9.1 Fluorene 7.7 Naphthalene 5.7 Carbazole 4.7Dibenzofuran 4.5 2-methylnaphthalene 1.8 Chrysene 1.2 Benzo(a)anthracene1.1 1-methylnaphthalene 0.9 Acenaphthene 0.6 Indene 0.6 Quinoline 0.4100% Hydrocarbon mixture Percent (1.27% of final solution) by weightPhenanthrene 29.3 Fluoranthene 12.6 Anthracene 10.3 Biphenyl 9.5 Pyrene9.1 Fluorene 7.7 Naphthalene 5.7 Carbazole 4.7 Dibenzofuran 4.52-methylnaphthalene 1.8 Chrysene 1.2 Benzo(a)anthracene 1.11-methylnaphthalene 0.9 Acenaphthene 0.6 Indene 0.6 Quinoline 0.4 TOTAL100%

1.27% (wt/wt) of the above hydrocarbon mixture may be mixed with 98.73%(wt/wt) DMSO solvent to obtain the final formulation. Different amountsof the hydrocarbon mixture and DMSO solvent may also be combined.

Mechanism of Action

The pentose phosphate pathway produces NADPH (nicotinamide adeninedinucleotide phosphate, reduced) at a high rate in all neoplastic cellsfor metabolism of tetrahydrofolate and rapid DNA synthesis, mitosis, andto produce enzymes to combat oxidative stress. The composition inhibitsthe hydrogen-donor functionality of NADPH during the conversion ofdihydrofolate to tetrahydrofolate by means of either electroninterference, non-competitive binding, or allosteric effect on NADPH.This arrests mitosis in neoplastic cells and thwarts gradual drugresistance by diminishing the cells' capacity to recycle glutathione andthioredoxin which scavenge excessive reactive oxygen species (ROS). Therole of NADPH as an essential source of reducing power for neutralizingthe high ROS levels of cancer cells can be found in Cairns & Harris,2011, Cold Spring Harbor Symposia on Quantitative Biology 76:299-311.

Research Studies

The composition from Koppers, Inc. was tested at the U.S. NationalCancer Institute in a one dose/60 cell line panel of cancer cell linesat a concentration of 100 μg/ml and was shown to be cytotoxic at a levelof 100% to glioblastoma multiforme cells (U251) and by 91% toastrocytoma cells (SF-268). See FIG. 2.

The composition reduces the adherence of certain neoplasms to type IVcollagen. Type IV collagen is responsible for the high density of cancertumors. As an adjunct therapy, inhibition of cancer cell adhesion totype IV collagen would promote drug-penetration intratumorally byreducing the density of tumors and the “outward” systolic pressure theyapply to flush out chemotherapeutics. In certain embodiments, the coaltar product can be combined with another chemotherapeutic or injectedalone prior to the use of another drug to increase the tumor's porosityand reduce its ability to flush out the drug by systolic pressure.

TABLE 13 Coal tar conc. % inhibition of adhesion of μg/mL (% w/v) M14cells to type IV collagen 500 (0.5%)   89%    50 (0.005%) 90      5(0.0005%) 62      0.5 (0.00005%)   8

Glioblastoma is highly vascularized tumor with cells that are tightlycompacted with high levels of collagen types IV and VI. It has beenshown in human glioblastoma cell lines U251, U87MG and LN229 that typeIV and type VI collagen promote upregulation of the angiogenicstimulant, vascular endothelial growth factor. Mammoto et al, Role ofcollagen matrix in tumor angiogenesis and glioblastoma multiformeprogression, Am J Pathol. 2013 October; 183(4):1293-1305. Because TypeIV collagen plays a supportive role in tumor angiogenesis andglioblastoma progression it is anticipated that a coal tar product, byinhibiting the binding of Type IV collagen to malignant cells within aglioblastoma tumor, would exhibit antiangiogenic effects and slowprogression.

Liposomes, microspheres and drug-implanted polymers are feasible drugcarriers for the composition.

2% and lower solutions of coal tar USP (from which the composition issourced and purified) is considered safe by the FDA for transdermaldelivery. See the creosote toxicology profile found at the Agency forToxic Substances and Disease Registry's website.

Example 5—Treatment Using Low Concentration of Composition Derived fromCoal Tar

Several early stage basal cell carcinomas on the patient's left foreheadwere treated for 12 days with 0.3% of the composition of Example 4 inDiPG/alcohol solution applied topically twice daily. This led to theshrinkage of the early stage basal cell carcinomas, as shown in FIG. 8A(before treatment) and FIG. 8B (after treatment).

What is claimed is:
 1. A method for treating glioblastoma comprisingadministering to a patient in need thereof a therapeutically effectiveamount of a coal tar product.
 2. The method of claim 1, wherein the coaltar product is present in a pharmaceutical composition.
 3. The method ofclaim 2, wherein the pharmaceutical composition is administered using atechnique selected from the group consisting of intravenously,subcutaneously, and by inhalation.
 4. The method of claim 2, wherein thepharmaceutical composition is administered to a surgical cavity.
 5. Themethod according to claim 4, wherein the pharmaceutical composition isadministered to a surgical cavity utilizing a unit dosing dispensingdevice, a needle, a microneedle, a non-needle injection device, aprefilled applicator, a saturated wipe, or an adhesive bandage.
 6. Themethod of claim 2, wherein the coal tar product is coal tar USP.
 7. Themethod of claim 2, wherein the coal tar product is added to solvents ordiluents and comprises the following: Hydrocarbon Percent by weightPhenanthrene 29.3 Fluoranthene 12.6 Anthracene 10.3 Biphenyl 9.5 Pyrene9.1 Fluorene 7.7 Naphthalene 5.7 Carbazole 4.7 Dibenzofuran 4.52-methylnaphthalene 1.8 Chrysene 1.2 Benzo(a)anthracene 1.11-methylnaphthalene 0.9 Acenaphthene 0.6 Indene 0.6 Quinoline 0.4 TOTAL100%.


8. The method of claim 2, wherein the pharmaceutical compositioncomprises: Coal tar USP 0.005 to 2% DiPG  1% to 15% Grapeseed oil orcastor oil 2% to 5% Water to 100%


9. The method of claim 1 further comprising administering to the patientat least one additional treatment of the glioblastoma selected from thegroup consisting of temozolomide, carmustine, lomustine, vincristine,cisplatin, bevacizumab, etoposide, procarbazine; and a polylactic acidscaffold; or combinations thereof.
 10. The method of claim 1, furthercomprising administering to the patient an alkylating agent.
 11. Themethod of claim 1, further comprising administering to the patient anangiogenesis inhibitor.
 12. The method of claim 1, wherein administeringto a patient in need thereof a therapeutically effective amount of acoal tar product comprises topically applying to the lining of apost-surgical cavity a therapeutically effective amount of a coal tarproduct.
 13. The method of claim 1, wherein a concentration of coal tarproduct is delivered to a tumor is sufficient to inhibit adhesion ofcancer cells to type IV collagen.
 14. The method of claim 13, whereinthe adhesion of cancer cells to type IV collagen is inhibited by atleast 8%.
 15. The method of claim 1, wherein the coal tar product has aconcentration between 0.5 μg/mL and 500 μg/mL.
 16. A method ofsensitizing glioblastoma to radiation treatment by inhibiting orinterfering with the reducing-capacity of NADPH comprising administeringto a patient having glioblastoma a therapeutically effective amount of acoal tar product.
 17. The method of claim 16 wherein the patient is thenadministered a therapeutically effective dose of radiation at the sametime as or after being administered the coal tar product.